Tobacco is the primary cause of preventable deaths. In India, the smokeless tobacco epidemic is acute and rising, killing hundreds of thousands. According to the 2010 Global Adult Tobacco Survey, there are almost 275 million tobacco users (age 15+) in India, and 80% of those users are consuming some form of smokeless tobacco.
Smokeless tobacco is an overlooked public health menace. Scientific evidence has found that consumption of smokeless tobacco causes oral, esophageal, pancreatic cancer and precancerous lesions, and reproductive and developmental problems.
According to a Public Health Foundation of India report, the economic burden of smokeless tobacco is Rs 23,364.2 crore. Indian policymakers must act decisively to reduce all tobacco use. The Cigarettes and Other Tobacco Products Act, 2003 (COTPA) is a robust law. However, it is not fully enforced and not yet fully aligned with the guidelines of the WHO Framework Convention on Tobacco Control (FCTC).
Evidence-based policies to combat the widespread use of smokeless tobacco include: Restricting the sale of smokeless tobacco products; higher taxes; large graphic health warnings; and bans on tobacco advertising, promotion and sponsorship.
Tobacco prices are also still too low. The Centre should continue to increase tobacco taxes, so they are at least 70% of the retail price, as recommended by the WHO and the World Bank. All tobacco products should be subject to the Goods and Services Tax.
Late last year, the Union health minister announced that, effective as of April 1, new pictorial warnings will cover 85% of space on all tobacco packages. It is important that these warnings are meaningfully implemented on smokeless tobacco products as well. The prescription of a minimum package size for all products will go a long way in ensuring that.
With regard to tobacco advertising, promotion and sponsorship, the government should close the gaps in COTPA by banning all point-of-sale advertising.
Indian policymakers must view smoked and smokeless tobacco equally harmful and implement aggressive policies to reduce their use and, ultimately, save lives.
Prakash Gupta is director, Healis-Sekhsaria Institute for Public Health, Mumbai, and Dorothy K Hatsukami is professor of psychiatry, University of Minnesota, US. The views expressed by the authors are personal.